Experiences of a med student with an incurable travel bug.

Archive for January, 2008

Kampala, Uganda

During our last few days in Kampala, I shadowed doctors at Mulago hospital for three days, one day each in Endocrinology, the Labor Ward, and Pediatrics.

Monday: Everyone in Endocrinology had Type II diabetes, often with other afflictions and always with the diabetic foot; several patients had gangrene. We went to some of the local craft markets on Buganda Road and at the National Theatre to have a look around and then met Annette for dinner (liver, rice and chips). Annette was the other doctor who showed us around last year with JB, and she’s incredible. Quite the life story, but she’s one of the only Ugandans I know who likes schedules and organization — it’s a nice change!

Tuesday: The Labor Ward was positively overflowing, with women on the floors and in the hallways nearly ready to give birth. I even saw a live birth, it was amazing! Now I’ve held the youngest baby in my life; the baby came out, it’s cord was cut, it was wiped off a bit and put into a blanket, and then the sisters let me pick him up! Less than three minutes old and he was holding my finger and trying to suckle the air — it’s amazing! That night we went to Krua Thai with Regina, another woman we met last year. She runs the CHAIN program that a few of us visited and that I looked closely at for my research project last January. She took us to her house afterwards for drinks and to show us the promotional video they’ve made for CHAIN.

Wednesday: In pediatrics the doctor would see each child for maybe 10 minutes before the next one came in, and he was still hardly able to make any progress through the huge line of people waiting. Nearly every child we saw had a herniated umbilicus (I believe that’s what he called it), and of course there were TB and other illnesses. Their pediatric operating room wasn’t able to be used for a month already when I was there as sewer was backing up into it, and they figured it would be at least another month before it would be open again. This lead to many cases that should have been operated on being postponed indefinitely, with only the most emergent being refered. Just the previous day they had someone come in with a severely broken foot, with one of the bones cutting through the skin. The doctors had want to properly set the break through surgery, but as they were unable to they just filed down the protruding bone, set the foot and sent the child on his way. Unfortunately it seems as though this is going to continue for some time. That night we met up with Miriam, a girl who came to the UW for a month last year and Molly got to know, for tea and sandwiches at her home. She’s married and pregnant now, so that was exciting!

That night we finished up our packing and got ready to leave at 5am to catch our flight to South Africa.

The morning of our flights was sufficiently chaotic. At 6am we were checking in for our flight to Johannesburg, at which point the woman behind the counter informed us that my luggage was about 20 kilograms overweight. uhhh, what?!? Having checked all the luggage restrictions before leaving, I knew that I should have been allowed two bags at 23 kilos each since my origin point for the trip was the US; however, since we were checking back in at Entebbe/Uganda, they decided we should only be allowed 23 kilos total, the limit for flights within the continent. After attempting to sort it all out with the one South African Airways person working at that hour, I redistributed weight as best I could and ended up paying ~$200 to get everything here, as did Molly. Positively ridiculous, but I’m working with SAA to try to get it refunded.

The layover in Joburg was relatively painless apart from the impressively pushy employees. Porters insisted on pulling our luggage, literally wrestling it out of our hands, even after we told them several times that we had zero money. When we got to our point to check back in as we had to go through customs, they lingered and insisted we tip them for the 50 foot journey. Nope, we told them we didn’t have anything and we weren’t lying, we hadn’t been able to exchange or withdraw any cash yet. In our line to check back in we were surrounded by two big groups of bikers, likely heading to Cape Town to train for the upcoming race. A uniformed employee ushered us through to the counter since we’d be quick and the bicyclists were going to take a looong time. Of course, after we checked our stuff he follows us half way to our gate, demanding a tip. As we still didn’t have money, and he really didn’t do anything, there was no tip for him either. After all of this and Joburg’s reputation for losing the most luggage of any airport on the planet, we were convinced that our luggage would never make it to Cape Town. After the two hour flight, we waited for quite a while for our luggage to come off the plane, and miraculously it all made it!! We couldn’t believe it, so many other people I’ve met here lost luggage coming through Joburg.

There was someone from UCT waiting for us at the airport, and after a few more students arrived a big van took us to all our different houses, dropping each of us off on the curb with our luggage and driving off. Apparently they had called ahead to all of our landlords, so there was someone to let us in.

So, after three weeks of constant travel, I arrived in Cape Town! I’m living a beautiful old historic Victorian row home, just two houses down from the first house my Aunt Mona lived in when she moved to Cape Town!! Small world. My room is on the second floor at the top of the stairs, overlooking the back garden. It’s painted green and has old wooden furniture; it’s very nice. The living room is painted a deep red with white covers on the couches, and the kitchen is in good condition. This place is so much nicer than any student housing at Madison, and cheaper! I even have my own room, and it’s almost twice the size of the room I’m going to have next year!

Lyantonde, Uganda

So we’re finally back in Kampala after two weeks in rural Uganda. You already heard about our time in Kabale, so I’ll pick up at the end of our stay there…

We left Kabale on Monday morning, taking a matatu to Lyantonde. It was pure chaos getting one; a lot of buses and matatus turn around in Kabale, so there are a lot there and every driver is competing for the business. Dozens of people were shouting prices and destinations at us, fighting with each other when we’d start to go to someone else. With the help of Elias, we finally escaped into a matatu for a reasonable rate. What’s a matatu, you ask? Only the worst form of public transportation known to mankind. It’s a van, not quite full size but not really mini either, with four rows of bench seats and fold-out seats crammed behind the driver’s row. Three people can comfortably sit next to each other on each row, which means there are always at least five people jammed into each row, more if you’re lucky. What’s really great about long journeys, like the five hour trip from Kabale to Lyantonde, is that everyone has baggage too, which is all piled on your lap. Then, if you’re really lucky, you happen to end up in one that distributes newspapers, so in addition to screeching to a halt every few kilometers to pick up more people you get to stop even more frequently to pick up and distribute huge bundles of papers. The matatu’s seem to have the same motto as Irish families – there’s always room for one more. After we had 20 people plus bags and newspapers loaded in, I was certain we had to be full. Nope. We got at least another four people in there, maybe more but it’s hard to count when you can’t see everyone that’s being sat on. Really, it’s awesome, you should try it.

After arriving in Lyantonde, we went to our friend Lillian’s house, a contact of ours through Village Health Project, and spent some time with her and Anna, another Wisconsin student who’s staying there for a month. Anna will be helping Lillian conduct interviews with the Family Care Workers of the Community Based Integrated Nutrition (COBIN) group that we also work with. We found out that since they were busy with the interviews, there wasn’t really much we could do with the water projects or COBIN at the time. Instead, we would be able to shadow doctors at the Lyantonde District Hospital, which we had hoped to do as well.

Working at the hospital was very interesting. Each day we got to work in a different area, though primarily with the same doctor.

Day 1: HIV Clinic. Molly helped distribute meds with Hiral, the closest person they have to a pharmacist. I sat in on appointments with the doctor. One of the patients was a six year old girl who looked about three as the HIV had stunted her growth so much. None of the adults that we saw weighed more than ~95 lbs, most of them were significantly less than even that.

Day 2: Antenatal (aka Prenatal in the US). We spent the day with the nurses/midwives in the antenatal clinic. We sat in on an education session, of which we understood nothing as it was in Lugandan, but we got the Women’s Health Passport that they give to the women, so we just went through that for the info. It’s a booklet issued to each patient that has info on everything from their own health records (each pregnancy is documented in the book) to what they need to bring with them to the hospital to give birth (sheets, food, gauze, etc as the hospital has virtually nothing). The patient keeps this booklet and brings it with them to each visit. We then went to the exam room and watched the check-ups. General health is checked, and each woman is tested for HIV if her status is unknown. We were able to check the blood pressure and listen for the fetal heartbeat in some patients, and to feel the abdomen and locate the fetus’s head in others. Listening for the fetal heartbeat was very difficult; they just use this small black cone pressed against the abdomen as they seldom do ultrasounds (this hospital may not even have the equipment).

Day 3: SURGERIES! Probably the most interesting day of the week. We were right in the OR with the surgeon, so we had to scrub up. You wouldn’t think that putting on scrubs would be all that difficult, but when the top is roughly the size of a circus tent and each pant leg could comfortably house a family of four, it suddenly becomes quite the project. I was lucky enough to have a drawstring in my pants that, after considerable wrenching, pulling, shifting and shuffling I was eventually able to utilize. Molly, however, only had what must have once been an elastic waist and was now a limp opening the size of a hula hoop, which she ended up tucking into her underwear in order to keep them up. Once we put on the white rainboots, we felt, and undoubtedly looked, distinctly like Oompa Loompas. I assure you, it was the pinnacle of style. We also got scrub caps and masks, completing the outfits. In the morning we watched a Cesarean section. It was very bloody and the doctor said the surgery usually wasn’t so messy, but the fetus was in distress so they had to work quickly. The baby seemed huge when he pulled it out, we’re guessing around 10 lbs, and it was blue from lack of oxygen. It took a while, but they were able to resuscitate her. She was then wrapped in a blanket and left wailing on a bed in another room while they finished working on the mother. Molly and I got to hold her, easily the youngest baby I’ve ever held at less than an hour old!

That afternoon we watched a hysterectomy, which was a much cleaner surgery. The only anesthetic they have at the hospital is (frequently expired) ketamine, so the patient’s aren’t totally out during the operation. Both women would move their arms or legs on occasion, and their gut was never calm. During the hysterectomy the woman’s eyes were open for nearly the whole thing, and clearly not all of the pain was blocked, but they usually don’t remember it after waking up. There’s virtually no equipment or staffing available to do anything remotely high-tech, so there’s no suction, no monitoring equipment, and the patients have to breathe entirely on their own. It was crazy; we had more equipment and drugs when I worked with monkeys than they have here for people.

All in all, it was a really great day. I didn’t have any trouble watching the surgeries; I wondered how it would go but I didn’t have to sit down or take a break or anything. Still, as awesome as it was to watch, I’m not sure that it’s something I would want to do all the time; parts of the procedures can get pretty physical, which I wouldn’t enjoy. Very interesting to observe though! I’ll save the blood and guts details, though.

Day 4: Pediatrics. We did ward rounds in pediatrics where nearly every kid had malaria plus pneumonia, anemia, or malnutrition. There were two families on every bed, some families with multiple ill children, plus extra mattresses on the floor – overflowing, to say the least. We also went through the women’s ward to check up on the patients from the surgeries; it was here that we saw someone with a terrible case of Herpes, a common opportunistic infection for those with HIV. This woman looked like she had been horribly burned and skinned; the skin was gone across her right shoulder, the top of her chest and back, and up her neck. I’m sure you can find similar pictures on google if you want a visual, but it was awful, I can’t imagine the pain.

That afternoon we both helped Hiral distribute meds again. We’d just count out pills in lids or on the counter with our bare hands, put them in plastic baggies, give them to the patient, sign the chart, and then start counting the next batch. All of this would be highly illegal and against health code in the US, but they were just happy to have people who could count to 30 and were willing to help since we made it go faster. After finishing Hiral took us to see the Muslim clinic his mother runs, which was run with a great deal more organization than the district hospital, though I’m sure that’s easier with a smaller clientele.

Each night that week we went over to Lillian’s to hang out with Anna. If the power was on, which was fairly unpredictable, we’d watch movies. Here you can get one DVD with 6-8 different movies on it, usually with a related theme. We were lucky enough to have a J.Lo one, so we had quite the J.Lo marathon. I had no idea she had so many movies and most of them I’d never normally watch, but it was nice to have a little piece of home like that. If there’s power and a tv, the only thing that’s ever on is futbol or terrible Nigerian movies, so it was nice to have something familiar.

Saturday morning we headed back to Kampala after a delicious breakfast; we bought fresh chapatti and a pineapple from the street vendors, all for about $0.80. mmmm. Then we tackled getting a bus. It was a bit less chaotic, but this time we were all on our own. We finally made it onto a bus (we weren’t doing a matatu again!), but only after getting past the matatu drivers who were physically blockading us from getting on. After we got on they decided to change a tire, which took a solid hour but at least we had a bus. Then the tire blew about 30 km outside Kampala; luckily they didn’t stop to fix it, otherwise we would have been delayed even longer. Though it was a far superior journey to the matatu escapade, it was a relief to arrive and go back to Kampala City View, where we’ll be staying until Thursday when we leave for Cape Town!

Kabale, Uganda

I’m writing this from Kabale, where we will be until Monday when we head to Lyantonde. It’s so beautiful here; the village is situated in the valley between these massive hills (I’ve heard them referred to as mountains, but they’re not quite that big) that are very lush and fertile — you can see all the different little cultivated plots right up to the very top. It’s cold here, as in I wore my cuddle duds for the first two days, but once it stops raining and the sun comes out, the temperature is perfect. Today was the nicest day so far, it didn’t rain at all.

On Thursday we went to town for lunch and got caught in the rain. Everything stops when it rains here; the drops are big and heavy, and it just pours to varying degrees for quite some time. Being so high up it seems to come out of nowhere sometimes, dumping tons of rain and then just disappearing again. We got bicycle-bodas with umbrellas to get us to the cafe once it started to let up — bikes are everywhere here, and a lot of guys have cushions situated behind their seats to accommodate for a second rider, turning themselves into taxis! It’s great, once you get used to riding side-saddle and having semis careen past at full speed about one foot away. That afternoon we went to the closest “hot springs,” which turned out to be a warm mud hole, more or less, haha. Then we went to the Rwandan border and crossed for a bit, but there wasn’t anything too close and we couldn’t take the car across. Especially owing to the Kenyan borders being closed and the resulting fuel crisis, there were huge lines of oil tankers (empty and full) trying to go in both directions across this border.

Yesterday we went to Lake Bunyoni, the deepest lake in Uganda at 6,500 ft deep. It was clearly an area that caters to American muzungus that the depth wasn’t in meters. The lake was gorgeous, big, winding, and clear, at the base of a valley with lots of islands that rose straight out of the water as big hills, just like those on the shore line. There wasn’t really any beach, just water then steep slopes, with resorts carved into them. We spent the night at Bushara Island, the nicest one, where we stayed in a “treehouse” for a whopping $36/night. Our treehouse was actually a round house of sorts made of wood planks and a thatched roof, set on the side of the hill with a fantastic view of the lake off our porch and through our windows. There was a door off our room leading to an open-air shower (walls but no ceiling) and a compost toilet as it was an eco-tourism facility. Had delicious crayfish chowder for dinner!

I’ve been eating a mix of local and more “American” foods, but everything they make has a distinctively different flavor…I’m still not certain how you can change spaghetti, but rest assured it’s possible. I had chicken sweet and sour upon our return to Kabale today, and it was good but definitely different…I’m pretty sure they put everything in the same brown sauce, which might account for it. They bring you so much food here; usually one order is way more than enough for Molly and I to share and not finish! The service is great too…very friendly, and it takes an average of an hour to get your food, longer if it’s not traditional food, lol.

We’re staying at the Rukundo compound again now that we’re back in Kabale. JB and Joe have returned to Kampala for James’s 30th wedding anniversary today and to finish some work on their projects, so it’s just Molly and I staying here with the houseboy, JB’s cousin Elias. We’re going to ask him to teach us how to make kashara, a porridge, and maybe some other things (he makes a very good matooke-Irish(potato)-cauliflower mix). On Monday we’ll head to Lyantonde where we will check up on our water projects and work with a community health program. We plan to return to Kampala, the capital, on the 26th, where we will be staying in the Kampala City View guest house. It’s close to Mulago hospital, which is great as I just found out that I will be able to do rounds there with the doctors and medical students in surgery, pediatrics, and medicine upon our return! That should be very interesting, as long as they don’t expect much input on my part!
Hope all is well!